Background
Methods
Study design and setting
Measurement
Explanatory variables
Individual-level factors | |
---|---|
Child factors | |
Age of child (months) | Categorized into (1) 0–11; (2) 12–23; (3) 24–35; (4) 36–47; and (5) 48–59. |
Sex of child | Categorized into (1) female and (2) male. |
Birth weight (g) | Categorized into (1) low < 2500 and (2) normal ≥ 2500. |
Type of birth | Categorized into (1) single and (2) multiple birth |
Immunization | Categorized into (1) incomplete or (2) complete |
Anemia | Categorized into (1) non-anemic; (2) mild; (3) moderate; (4) sever |
Maternal/household factors | |
Maternal age in years | Categorized into (1) 15–24; (2) 25–34; or (3) 35–49. |
Educational level of mother | Categorized into (1) no formal education; (2) primary; (3) secondary; or (4) higher. |
Mother’s body mass index (kg/m2) | Categorized into (1) <18.5; (2) 18.5–24.9; or (3) ≥ 25.0. |
Birth interval (months) | Categorized into (1) ≥24 and (2) <24. |
Number of under-fives children | Categorized into (1) 1; (2) 2; (3) 3; or (4) ≥4. |
Head of household | Categorized into (1) male or (2) female. |
Wealth index | Categorized into (1) (first quintile) (Poorest); (2) (second quintile); (3) (third quintile); (4) (fourth quintile); or (5) (fifth quintile) (Richest) |
Community-level factors | |
Residence Poverty rate | Categorized into (1) rural or (2) urban. Proportion of households living below poverty level (wealth index below 20 %, poorest quintile). Categorized into (1) Low or (2) High. Median value serves as the reference for the low and high groups. |
Region | Categorized into (1) Dire Dawa; (2) Tigray; (3) Afar; (4) Amhara; (5) Oromiya; (6)Somali; (7) Benishangul-Gumuz; (8) SNNP; (9) Gambela; (10) Harari; (11) Addis Ababa |
Latrine facility type | Categorized into (1) improved (access to flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet and does not share this facility with other households) or (2) unimproved. |
Drinking water sources | Categorized into (1) piped water; (2) Other improved (protected spring and well, and rain water); (3) unimproved (river, pond, unprotected spring and well). |
Ethical considerations
Results
Characteristics of the study participants
Variables | Weighted Frequency | Weighted Percent |
---|---|---|
Place of residence | ||
Urban | 1,528 | 12.9 |
Rural | 10,344. | 87.1 |
Maternal education | ||
No formal education | 8,227 | 69.3 |
Primary | 3,211 | 27.0 |
Secondary | 266 | 2.2 |
Higher | 168 | 1.4 |
Father’s education level | ||
No education | 5,878 | 50.22 |
Primary | 4,866 | 41.58 |
Secondary | 584 | 4.99 |
Higher | 376 | 3.22 |
Wealth index | ||
Richest | 2,173 | 15.1 |
Richer | 1,870 | 19.1 |
Middle | 1,872 | 20.5 |
Poorer | 2,114 | 22.4 |
Poorest | 3,625 | 22.8 |
Child’s age(months) | ||
0–11 | 1,060 | 11.43 |
12–23 | 1,833 | 19.76 |
24–35 | 1,963 | 21.17 |
36–47 | 2,264 | 24.41 |
48–59 | 2,154 | 23.23 |
Sex | ||
Female | 5,704 | 48.05 |
Male | 6,168 | 51.95 |
Anemia | ||
Non-anemic | 4,983 | 55.40 |
Mild | 1,953 | 21.71 |
Moderate | 1,839 | 20.44 |
Severe | 220 | 2.45 |
Mother’s BMI (kg/m2) | ||
18.5–24.9 | 8,605 | 72.61 |
<18.5 | 2,470 | 20.84 |
> = 25.0 | 776 | 6.55 |
Birth interval | ||
<24 months | 2,275 | 23.73 |
> = 24 months | 7,313 | 76.27 |
Head of household | ||
Female | 1,767 | 14.88 |
Male | 10,105 | 85.12 |
Region | ||
Dire Dawa | 39 | 0.3 |
Tigray | 753 | 6.3 |
Affar | 121 | 1.0 |
Amhara | 2,656 | 22.4 |
Oromiya | 5,014 | 42.2 |
Somali | 364 | 3.1 |
Benishangul-Gumuz | 140 | 1.2 |
SNNP | 2,494 | 21.0 |
Gambela | 40 | 0.3 |
Harari | 28 | 0.2 |
Addis Ababa | 222 | 1.9 |
Improved latrine facility | ||
Yes | 860 | 7.46 |
No | 10,668 | 92.54 |
Drinking water supply | ||
Piped water | 616 | 10.36 |
Other improved | 1,084 | 18.24 |
Unimproved | 4,243 | 71.39 |
Spatial variation of stunting
Region | Weighted number | Weighted Prevalence of stunting (95 % CI) | Excess Risk | |
---|---|---|---|---|
Stunted | Normal | |||
Tigray | 346. | 332 | 51.0(47.3–54.8) | 1.15 |
Afar | 50 | 52 | 51.0(41.3–60.6) | 1.15 |
Amhara | 1175 | 1,088 | 51.9(49.9–54.0) | 1.17 |
Oromiya | 1,838 | 2,594 | 41.5(40.0–43.0) | 0.93 |
Somali | 92 | 189 | 32.7(27.5–38.5) | 0.73 |
Benishangul-Gumuz | 58 | 60 | 49.4(40.2–58.1) | 1.11 |
SNNPa | 965 | 1204 | 44.5(42.4–46.6) | 1.0 |
Gambella | 9 | 23 | 28.0(14.7–45.4) | 0.63 |
Harari | 7 | 16 | 30.3(14.4–51.1) | 0.68 |
Addis Ababa | 39 | 144 | 21.7(15.8–27.6) | 0.48 |
Dire Dawa | 12 | 22 | 36.4(21.4–53.6) | 0.79 |
Place of Residence | ||||
Urban | 391 | 876 | 30.8(28.4–33.5) | 0.69 |
Rural | 4,202 | 4,844 | 46.4(45.4–47.5) | 1.04 |
Total | 4,593 | 5721 | 44.5(43.6–45.5) |
Region | Total number of clusters | High hotspots* | Low hotspots** | Non-significant clusters*** |
---|---|---|---|---|
Tigray | 58 | 52 | 1 | 5 |
Afar | 42 | 28 | 2 | 12 |
Amhara | 68 | 40 | 4 | 14 |
Oromiya | 73 | 3 | 21 | 49 |
Somali | 35 | - | 16 | 19 |
Benishangul-Gumuz | 46 | 39 | 1 | 6 |
SNNP | 79 | 1 | 3 | 75 |
Gambela | 46 | 1 | 33 | 12 |
Harari | 42 | - | 39 | 3 |
Addis Ababa | 52 | - | 49 | 3 |
Dire Dawa | 40 | - | 39 | 1 |
Multilevel analysis
Variables | Model 2 | Model 3 | Model 4 |
---|---|---|---|
AOR(95 % CI) | AOR(95 % CI) | AOR(95 % CI) | |
Individual level factors | |||
Child factors | |||
Child’s age(months) | |||
0–11 | 1.00 | 1.00 | |
12–23 | 4.13(3.23–5.27) | 4.12(3.22–5.26) | |
24–35 | 6.47(5.07–8.25) | 6.61(5.17–8.44) | |
36–47 | 6.37(5.00–8.10) | 6.44(5.10–8.20) | |
48–59 | 5.58(4.38–7.12) | 5.65(4.43–7.21) | |
Sex | |||
Female | 1.00 | 1.00 | |
Male | 1.20(1.08–1.37) | 1.20(1.08–1.33) | |
Immunization | |||
Complete | 1.00 | 1.00 | |
Incomplete | 1.01(0.76–1.34) | 1.01(0.76–1.34) | |
Anemia | |||
Non-anemic | 1.00 | 1.00 | |
Mild | 1.36(1.18–1.56) | 1.43(1.24–1.64) | |
Moderate | 1.64(1.42–1.89) | 1.76(1.52–2.03) | |
Severe | 2.93(2.14–4.01) | 3.23(2.35–4.43) | |
Maternal/household factors | |||
Mother’s age (years) | |||
15–24 | 1.00 | 1.00 | |
25–34 | 0.95(0.82–1.10) | 0.96(0.83–1.11) | |
35–49 | 0.92(0.76–1.10) | 0.93(0.77–1.12) | |
Maternal education | |||
No education | 1.00 | 1.00 | |
Primary | 0.88(0.76–1.02) | 0.90(0.78–1.04) | |
Secondary | 0.64(0.41–1.01) | 0.70(0.44–1.10) | |
Higher | 0.43(0.19–0.97) | 0.42(0.18–0.94) | |
Mother’s BMI (kg/m2) | |||
18.5–24.9 | 1.00 | 1.00 | |
<18.5 | 1.08(0.95–1.22) | 1.13(1.00–1.28) | |
> = 25.0 | 0.65(0.49–0.85) | 0.69(0.52–0.90) | |
Birth interval | |||
<24 months | 1.00 | 1.00 | |
> = 24 months | 1.72(1.50–1.98) | 1.68(1.46–1.93) | |
Number of under five children | |||
One | 1.00 | 1.00 | |
Two | 0.88(0.77–1.01) | 0.90(0.79–1.03) | |
Three | 0.88(0.73–1.06) | 0.95(0.79–1.14) | |
Four | 0.79(0.58–1.19) | 0.90(0.61–1.33) | |
Head of household | |||
Female | 1.00 | 1.00 | |
Male | 1.14(0.98–1.32) | 1.18(1.01–1.38) | |
Father’s education level | |||
No education | 1.00 | 1.00 | |
Primary | 0.98(0.87–1.11) | 0.98(0.87–1.12) | |
Secondary | 0.64(0.49–0.85) | 0.74(0.56–0.99) | |
Higher | 0.50(0.33–0.76) | 0.58(0.38–0.89) | |
Family size | |||
≤4 | 1.00 | 1.00 | |
5–7 | 1.03(0.88–1.20) | 1.03(0.88–1.20) | |
8–10 | 1.05(0.86–1.27) | 1.05(0.86–1.28) | |
≥11 | 1.21(0.86–1.71) | 1.20(0.84–1.70) | |
Wealth index | |||
Richest | 1.00 | 1.00 | |
Richer | 1.74(1.39–2.17) | 1.46(1.12–1.90) | |
Middle | 1.57(1.25–1.98) | 1.24(0.94–1.64) | |
Poorer | 1.82(1.45–2.29) | 1.42(1.08–1.88) | |
Poorest | 1.73(1.39–2.17) | 1.43(1.08–1.89) | |
Community level factors | |||
Place of residence | |||
Urban | 1.00 | 1.00 | |
Rural | 1.79(1.49–2.16) | 1.18(0.88–1.60) | |
Poverty rate | |||
Low | 1.00 | 1.00 | |
High | 1.02(0.88–1.20) | 1.01(0.84–1.23) | |
Region | |||
Dire Dawa | 1.00 | 1.00 | |
Tigray | 1.63(1.23–2.16) | 1.58(1.09–2.29) | |
Affar | 1.65(1.23–2.21) | 1.27(0.86–1.86) | |
Amhara | 1.62(1.23–2.15) | 1.50(1.04–2.17) | |
Oromiya | 1.01(0.77–1.32) | 1.13(0.79–1.62) | |
Somali | 0.80(0.59–1.09) | 0.68(0.46–1.01) | |
Benishangul-Gumuz | 1.49(1.11–2.01) | 1.71(1.16–2.52) | |
SNNP | 1.17(0.89–1.54) | 1.43(1.00–2.06) | |
Gambela | 0.57(0.47–0.78) | 0.57(0.37–0.86) | |
Harari | 0.73(0.52–1.01) | 0.72(0.46–1.12) | |
Addis Ababa | 0.78(0.53–1.14) | 1.03(0.57–1.83) | |
Improved latrine facility | |||
Yes | 1.00 | 1.00 | |
No | 1.27(1.07–1.51) | 1.26(1.01–1.59) | |
Drinking water supply | |||
Piped water | 1.00 | 1.00 | |
Other improved | 1.13(0.97–1.32) | 1.03(0.85–1.25) | |
Unimproved | 1.06(0.87–1.29) | 1.04(0.87–1.24) |
Individual level factors
Community level factors
Measure of variation | Model 1a | P-value | Model 2b | p-value | Model 3c | p-value | Model 4d | p-value |
---|---|---|---|---|---|---|---|---|
Community level | ||||||||
Variance (SE) | 0.363(0.043) | <0.001 | 0.323(0.050) | <0.001 | 0.159(0.046) | <0.001 | 0.230(0.041) | <0.01 |
Explained variation(PCV) | Reference | 11.0 | 56.2 | 36.6 | ||||
ICC (%) | 9.9 | 8.9 | 4.6 | 6.5 | ||||
MOR | 2.10 | 1.93 | 1.59 | 1.75 | ||||
Model fit statistics | ||||||||
DIC (−2log likelihood) | 13256 | 8499 | 12733 | 8357 |